Tip for N/A (employer-specific)

Put your request in writing — verbal requests are valid but harder to prove

Tip for N/A (employer-specific)

You do NOT need to use the words 'ADA' or 'reasonable accommodation' — just clearly explain your need

Tip for N/A (employer-specific)

Your employer can request medical documentation but CANNOT demand your full medical records

Employment / FMLAmoderate

ADA Reasonable Accommodation Request

N/A (employer-specific) · Employers / SHRM / JAN

Request for workplace accommodation under the Americans with Disabilities Act. Triggers the interactive process between employer and employee. Written documentation is recommended though not legally required.

Form Details

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Where to Submit This Form

📬

Submit in writing to your employer's HR department

A written request creates an important paper trail. No specific federal form is required.

📧

Email to HR or your direct supervisor

Written email requests are recommended for documentation.

Required Attachments

📎 Letter from your healthcare provider describing your disability and functional limitations
📎 Specific accommodation(s) requested and how they enable you to perform essential job functions
📎 Medical documentation supporting the need (focus on functional limitations, not just diagnosis)

Processing Time

Employer must begin the 'interactive process' promptly — typically within 1-2 weeks. No fixed legal deadline for final resolution, but unreasonable delay may violate the ADA.

What Happens Next

Your employer must engage in an 'interactive process' to discuss and determine reasonable accommodations. They may propose alternative accommodations but cannot ignore the request entirely.

Tips for This Form

✓ Put your request in writing — verbal requests are valid but harder to prove
✓ You do NOT need to use the words 'ADA' or 'reasonable accommodation' — just clearly explain your need
✓ Your employer can request medical documentation but CANNOT demand your full medical records
✓ Common accommodations: modified schedule, telework, ergonomic equipment, job restructuring, reassignment
✓ File a charge with the EEOC if your employer fails to accommodate: https://www.eeoc.gov/filing-charge-discrimination

More Employment / FMLA Forms

FMLA Certification - Employee's Serious Health Condition

WH-380-E · U.S. Department of Labor

Certification of Health Care Provider for Employee's Serious Health Condition. Medical certification for FMLA leave for the employee's own condition.

FMLA Certification - Family Member's Serious Health Condition

WH-380-F · U.S. Department of Labor

Certification of Health Care Provider for Family Member's Serious Health Condition. Medical certification when employee needs leave to care for a family member.

FMLA Notice of Eligibility and Rights & Responsibilities

WH-381 · U.S. Department of Labor

Notice of Eligibility and Rights & Responsibilities. Employer must provide within 5 business days of FMLA leave request, stating whether employee is eligible.

FMLA Designation Notice

WH-382 · U.S. Department of Labor

Designation Notice. Employer designates leave as FMLA-qualifying or denies it. Must be provided within 5 business days of receiving sufficient certification.

FMLA Certification - Qualifying Exigency (Military)

WH-384 · U.S. Department of Labor

Certification of Qualifying Exigency for Military Family Leave. For leave due to a covered family member's active duty or call to active duty.

FMLA Certification - Serious Injury/Illness of Servicemember

WH-385 · U.S. Department of Labor

Certification for Serious Injury or Illness of Covered Servicemember for Military Family Leave (current servicemember).

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